Introduction

What is Tinnitus?

Tinnitus is a symptom rather than a diagnosis. It is the perception of sound that is not coming from the world around you. There are many different triggers and perpetuating factors.

What noise do people hear?

People describe hearing all different types of noises with their Tinnitus, and one individual may hear several different sounds.

Some examples of sounds heard include:

• Ringing
• Hissing
• Buzzing
• Whistling
• Humming
• Roaring
• Out of tune television
• Sea-shell type noise
• Shushing
• Static electricity
• Clicking
• Pulsating

How common is Tinnitus?

Tinnitus is VERY COMMON. Chronic Tinnitus is estimated to affect approximately 14% of adults, although some studies feel this number may be higher at 25-30%. Although it is a very common symptom, for most people it is mild, and doesn’t affect their quality of life. It usually resolves or eases significantly. It is felt that 1-2% of adults have severe Tinnitus, affecting their quality of life. 

Children also often experience Tinnitus (they just don’t tell you about it unless you ask).

What causes Tinnitus?

If I had to explain why most people get Tinnitus in one sentence, my response would be “Tinnitus is likely to be a side effect of the brain trying to compensate for a change in our hearing”. 

This change could be a temporary or a permanent change.

Temporary changes include occlusive ear wax, infection, loud noise exposure, middle ear problems e.g. from a heavy cold, etc. Permanent changes include age-related hearing loss (part of normal aging), persistent loud noise exposure, medication which damages the inner ear, certain medical conditions, etc.

Stress and our emotional wellbeing also play a key role, and for some may be the primary trigger.

It is important to mention that people with ‘normal’ hearing can also experience Tinnitus. In fact, most people if kept in a sound-proof room for long enough will start experiencing Tinnitus.

The exact mechanism(s) within the brain which results in Tinnitus are not fully understood and there are different theories, relating to activity within the nerves themselves or how the brain adapts to changes in the hearing pathway.

Pulsatile and objective Tinnitus are different in their cause and mechanism. Most people experiencing these types of Tinnitus do NOT have a worrying cause (despite what you may have read on the internet). Nonetheless, these types of Tinnitus are usually investigated by a specialist to make sure there isn’t a significant structural cause, which requires intervention.

If you are worried about the cause of your Tinnitus, then this ‘worry’ itself can keep Tinnitus in your mind and conscious thought and stop it from improving.

There are various ways of investigating the cause of Tinnitus, including hearing tests, blood tests and scans. Investigations are not always required, and very much depend on the type, duration and intrusiveness of Tinnitus. It is best to consult a doctor who is experienced in investigating and treating Tinnitus, to make sure only appropriate investigations are arranged.

How is Tinnitus managed?

Unfortunately, there is a lot of misinformation on the internet, and regrettably from some Healthcare Professionals, regarding managing Tinnitus. Patients are incorrectly told that “there is nothing which can be done” and they will “just have to learn to live with it”.

This is NOT true and NOT helpful. Just because a condition may not be ‘curable’ does NOT mean that it is not ‘manageable’. There may not be a quick fix cure, but Tinnitus CAN be managed. 

Management is based on the principle that the brain can ‘ignore’ sound. Let me give you some examples…

1. 1. Imagine if you moved next to a train line. For the first few months you will hear (and even get woken up by) the trains going past. After a while, you stop hearing them…
   2. There are times when you are busy working and do not hear the traffic outside (until you think about it). Perhaps whilst you were reading the beginning of this leaflet you were not aware of the noises around you, until now, since you are now thinking about them.

Just as the brain can ignore sound on the ‘outside world’, the brain can also learn to ignore perceived sound from within the brain itself… Tinnitus.

‘Habituation’ is the process whereby you get used to the Tinnitus noise and become less interested in it, and concerned by it over time, resulting in you starting to ignore it. What helps this process is first and foremost ‘Time’ itself, but there are also some specific techniques and approaches covered below.

What stops this process, in my experience more than anything else, is ‘Stress’ and difficulties or challenges in our ‘Emotional and Psychological Wellbeing’. Additionally, ongoing Tinnitus Triggers, e.g. fluctuating hearing loss, will make Habituation harder.

Another important principle in Tinnitus management is that ‘The issue with Tinnitus is NOT the noise itself… The issue with Tinnitus is with how we REACT to that noise…’

What I mean by this is that two different people could hear the exact same Tinnitus sound in their ears and head but have very different responses to it. For one person, it becomes all they think about. It affects their sleep, and they stop socializing. The Tinnitus becomes more and more intrusive and a ‘downward spiral’ or ‘vicious cycle’ forms. For the second person, they continue their normal routines and activities. They implement the techniques detailed below… 

In which of these two people is the Tinnitus most likely to ease or settle??? They both started with hearing the exact same sound…

Although there is no current treatment to ‘remove’ the Tinnitus sound, there are management approaches which focus on changing how we react to, and feel about, Tinnitus.

So, what are the techniques and approaches to help manage Tinnitus?

Broadly speaking there are two main approaches used. 1) Using other sound to ‘distract’ oneself from tinnitus, and 2) Psychological based methods, e.g. Cognitive Behavioural Therapy (CBT) & Mindfulness, as well as approaches which try to improve and optimize our Stress Management & Emotional Wellbeing.

Sound Therapy / Sound Enrichment 

Tinnitus is often most noticeable, bothersome and/or intrusive, in quiet environments, e.g. at night-time when trying to go to sleep. 

Using sound can help manage tinnitus and is one of the most popular methods used. Using other sounds can distract you from the Tinnitus sound (it masks the Tinnitus). Using other sounds can also make the Tinnitus less intrusive and help ‘relax’ you. Sound Therapy is incredibly easy to implement and can be free or inexpensive (you can purchase certain bits of equipment if you wish – see below). It can be particularly helpful in trying to reduce the impact of your tinnitus on your sleep.

What Sounds to Use

There are a variety of sounds you can use as part of Sound Therapy. Having a window open so you can hear the traffic outside, or having a fan on in the room, are two simple examples. There are many Smartphone Apps available which will provide a variety of Sounds to use, e.g. forest sounds, rain, sound of the sea, etc. There are many free relaxing downloads or online videos which can be found. 

There are wearable sound generators, e.g. white noise generators, which can be used (these look like small Hearing Aids). In fact, some Hearing Aids, for hearing loss, will have a white noise generator setting. There are also portable sound generator machines available online.

Pillow speakers can be particularly helpful if your partner does not wish to hear the Sound Therapy sounds when they are trying to go to sleep. I do NOT advise sleeping with headphones on, and so a pillow speaker can be a very helpful option.

I usually advise listening to neutral and natural sounds, rather than spoken words or music. This is because you don’t actually want to give a lot of attention to the Sound Therapy sound, you simply want it to provide some distraction or have a calming effect. However, if a relaxing Audiobook or Music works well for you, then use this. Do what works for you…

Hearing Aids, if you have an underlying hearing loss (even mild), can also sometimes be helpful in managing Tinnitus. This can be because by having better access to environmental sounds when wearing the Hearing Aids, it will mask the Tinnitus. Having said this, many of my patients also find that even when they take their Hearing Aids off, the Tinnitus is less bothersome than before.

Psychological Based Methods

Cognitive Behavioural Therapy (CBT)

As mentioned above, the issue with Tinnitus is not the noise itself… the issue is with how one reacts to that noise. CBT therefore aims to change your REACTION to Tinnitus. It aims to change negative thoughts and beliefs by first IDENTIFYING them, next EVALUATING how valid they are, and then REPLACING them with more positive and realistic thoughts.

Response to treatment is dependent on your ENGAGEMENT with the therapy and therapist. It will take some time to see the beneficial effect of the CBT. Don’t forget to keep a positive attitude and good engagement, and you should see the improvements. Although it is ideal to see a Therapist who has experience implementing CBT for Tinnitus Management, this is not always possible, and an experienced CBT Therapist will likely be able to offer you help.

Mindfulness

Mindfulness is a technique where you are present and aware of the ‘here and now’, but most importantly, in an open and NON-JUDGEMENTAL way.

This approach aims to help with how you REACT to your Tinnitus. By paying attention to your Tinnitus, non-judgementally, you can change your NEGATIVE perception of the Tinnitus into ACCEPTANCE, which should help with HABITUATION, as well as your general Emotional Wellbeing. Although it is ideal to see a Therapist who has experience implementing Mindfulness for Tinnitus Management, this is not always possible, and an experienced Mindfulness Therapist will likely be able to offer you help.

Optimizing Stress Management & Improving Emotional Wellbeing

Stress and your underlying Psychological & Emotional Wellbeing are hugely important on how Tinnitus will affect you.

Your ‘Hearing System’ is linked to your ‘Emotional System’. Let me give you an example… You could hear a piece of music from your childhood and just hearing the melody could bring you to tears. Or you could hear a scary piece of music and it could make you feel fear, make your palms sweat and increase your heart rate. Hearing a sound can affect your emotions. It also works the other way around. When you are stressed, you tend to be less tolerant of loud or higher pitched sounds. Additionally, when you are stressed or going through a challenging emotional time, Tinnitus will be more bothersome.

If you can optimize your Stress Management and improve your Psychological & Emotional Wellbeing, it usually has a very positive effect on your Tinnitus Management.

Relaxation & Meditation

Relaxation & Breathing techniques can be very helpful in Stress Management.

One such exercise includes Progressive Muscle Relaxation. In a calm and peaceful room, lie on a bed or sit comfortably in a chair. Do not fold your arms or legs. Slightly slow your breathing and try to breathe in a steady, slow rhythm. First, tense your toes as tight as you can and hold them like that for a few moments, before releasing the tension. Then tense your ankles as tight as you can for a few moments before releasing. Then your calves, thighs and so on, slowly moving upwards in muscle groups, up the body to the head. This exercise can be repeated and should be calming.

Other Approaches & Techniques 

There are many other exercises and techniques which can be utilized, including Controlled Breathing, Meditation, Yoga, Pilates and Tai-Chi. Even having dedicated, ring-fenced, time each week for a hobby can be very helpful in optimizing your Stress Management.

Regular moderate exercise is also very helpful for improving our Mental Health & Emotional Wellbeing. Stay well hydrated with water, stick to a consistent meal schedule, and have a balanced diet.

Trying to get enough, and good quality sleep, should not be underestimated. Try to have a consistent sleep schedule. Avoid electronic devices for at least an hour before bedtime to minimize both exposure to ‘blue light’, as well as mental stimulation, just prior to sleep. Exercise earlier in the day and avoid stimulants, e.g. caffeine, after midday. Look up ‘Sleep Hygiene’ for further practical tips to try to help.

Seeing the Beneficial Effect

If you implement the techniques above, you should see a significant improvement in how you manage your Tinnitus, although these will take some time to work. For some people the Tinnitus does goes away completely, although I can never promise this, as there is no ‘cure’ to remove the sound. However, even if the Tinnitus doesn’t fully go away, it should be in the BACKGROUND, a bit like a fan on in the room… if you think about it, you will hear it, but most of the time you are NOT AWARE of it… it is in the background and NOT INTRUSIVE to your life.

DISCLAIMER: This blog post is meant for medical education purposes ONLY and DOES NOT constitute individual clinical advice. ALWAYS seek medical advice from your treating doctor, when managing health conditions. If you would like to arrange for a private medical consultation with Dr Shaw, Consultant Audiovestibular Physician, then information on booking an appointment can be found at  TheDizzySpecialist.com/contact. Face to face and virtual consultations available.

Dr Benjamin Shaw | Audiovestibular Consultant Physician | TheDizzySpecialist.com

I am an Audiovestibular Consultant Physician, based in London. I am a highly experienced and specialised Medical Doctor, who accurately diagnoses and effectively manages dizziness, vertigo, balance disorders, hearing loss & tinnitus. I am also a committed advocate for patients with these debilitating symptoms and create healthcare-related educational content, with the aim of empowering patients to better understand and manage their conditions.